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Bariatric surgery

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Bariatrics (from Greek βάρος “compressing” stomach) is a field of surgery dealing with overweight issues.

Bariatric methods affect the main reason of overweight reducing a need for meal and reflex of the stomach to collect and ingest meal.

Increasing statistical data state that more and more people from the developed countries use different types of surgery to correct their weight - it is safe and has a long-time effect.

Direct indications to bariatric surgery

  • morbid (life threatening) obesity. For men it is 45 kg extra, for women - 35 kg. This group consists of the patients with body mass index (BMI) over 40;
  • grade 1-2 obesity (BMI 30 to 40) complicated by cardiac and pulmonary abnormalities, diabetes, hypertensions.


You can calculate your Body Weight Index using the formula weight (kg)/square height (m). If your index is over 30, you should think about the changes in your lifestyle, diet and treatment.

Why is surgical treatment of obesity so popular?

  • it’s an easy way to resolve the problems related with the obesity, associated hormonal disorders, which treats up to 80% of patients with type 2 diabetes. Regular diet and physical activity cannot help such patients;
  • there is no need to change your lifestyle and eating habits – You can eat everything you used to;
  • there is no hunger – most interventions speed up the saturation period and thus there is no more need to “stuff” yourself;
  • self-assessment increases - the patient feels better, becomes really younger and quits alimentary addiction.


For many people it is a real chance to break pathological relations with a fridge, to decrease a risk of vascular pathology and to normalize their metabolism.

Most of such interventions do not require hospitalization and the effect can be observed within 2 weeks.

Ballooning

Palliative method consists of placing of a silicon balloon with water inside the stomach. In this case “volume saturation” is caused by presence of volumetric object in the stomach.

As a rule, a balloon contains 500ml of water and is supposed to be placed in the stomach for six months and then removed. Reduction of extra mass reaches 70%. It is supposed that by the time of removal the patient has got accustomed to less amount of food.

Disadvantages of the method:


  • digestion of the balloon. It should be replaced in half a year (healthfulness of silicon digestion is discussed);
  • when the balloon is removed, the volume of food necessary for satiety will increase as well as hunger after small portions will come back.


Ballooning can be advised to the patient who cannot undergo surgery due to the vascular risks (associated with hypertension together with diet-induced obesity).

Laparoscopic gastric banding

A special ring is installed on the upper third of the stomach. Therapeutic effect is based on the fact that most pressure receptors (nervous system interprets stretching of the wall of the stomach as satiety) are located in the upper segment.

The following occurs:

  • space of 40-50 ml is created in the upper segment of the stomach;
  • while eating the meal quickly fills this space and the wall at this segment stretches ;
  • receptors transmit information about the satiety (“if it is already stretched, than it is full) to the brain;
  • hunger disappears after several spoons of food.


Diameter of the ring can be adjusted by doctor after the surgery through a special port using a regular syringe (it is impossible to find a port if you don’t know about performing the surgery).

The procedure is performed in endoscopic manner during 40 minutes leaving no marks of manipulations. It does not damage the stomach (nothing is cut off), the banding can be removed at any time.

Disadvantages of the method:


  • patients who love the process of eating usually are not satisfied with the procedure. Quick satiety is interpreted as food “compaction”;
  • nutrition rules must be observed, otherwise a vomiting occurs when overeat.


Incompetent installation of the banding (when the organ is overtighten) can cause distention of the stomach above the ring and suppuration in the area of tightening. Gradual immersion of the ring in the stomach is rarer phenomenon.

Surgical Center ServiDigest in Barcelona (Spain) is a famous medical institution which makes laparoscopic gastric banding. The Hospital tends to use attenuated methods of bariatric interventions. It is popular due to a small amount of complications and affordable prices.

Gastric bypass surgery

This method is popular in Canada and the USA and is characterized by safety and long-time effect. A “small” stomach is formed surgically (endoscopically, without incisions) for the same purpose as those of banding.

A formed space of 20-50 ml is stitched to the small intestine. The rest of the stomach is left (unchanged?)(food does not get into it). Bile and duodenal secretion combine with the food via a separate anastomosis (conjunction).

Advantages of the bypass surgery:


  • quick and long-lasting satiety. Besides the reflex responding to the stitched walls, there is one more reflex when the food gets into the small intestine – organism receives a double signal of “full stomach”;
  • decreased nutrient absorption (bile and hydrochloric acid enter the stomach lower the usual entrance level);
  • no need (in comparison with the banding) to control the compression level after the surgery, less complications;
  • no foreign bodies are introduced in the organism.


This is an optimal method when the BMI is over 50. It is recognized as the gold standard to treat the morbid obesity.

In the Eastern Europe this operation is made in several medical institutions, one of which is St. Zdislava Hospital (Czech Republic, Vysočina). Popularity of the Hospital is based on the use of Da Vinci Surgical System and reputation of the Head of Surgical Department.

Operations are performed by Dr. Jaroslav Tvaruzer - a specialist who has recommendation of Intuitive Surgical (the company which created the 2Da Vinci Surgical Systems) for such surgical interventions in Europe.

Experience and assistance of the surgical system (already assisted in performance of over 2,000 surgeries) reduces possibility of complications after the gastric bypass surgery to the minimum.

Sleeve gastroplasty – modified bypass surgery

This method has developed from the standard bariatric bypass surgery. The main difference is in the artificial narrowing of the stomach when a narrow “sleeve” is formed but the organ is not removed or excluded.

This approach has been developed occasionally as it is difficult to make a single-stage bariatric bypass surgery in patients over 200kg and the first “sleeves” were created as temporary, intermediate measure before “exclusion” of the main part of stomach from the process of digestion.

Due to some technical issues some of these patients spent a long time with the narrowed stomach. It was noted that such patients lost up to 80% of overweight and there was no more need to exclude the stomach.

Advantages over classic surgery:


  • there are no strict tight restrictions on the volume of meal;
  • less possibility of dyspeptic disorders, no risk of demineralization which sometimes occur after bypass surgery;
  • if needed, there is possibility of comprehensive bypass surgery after formation of the sleeve (if effect of the sleeve is insufficient).


When applying with premorbid and morbid obesity, try to choose the hospital which provides both sleeve gastroplasty and classic bypass surgery. In this case you will be advised the type of the treatment which is the best in your case.

 

Teknon (Spain) is a famous hospital in Western Europe which proposes both types of surgical interventions.

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